Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya30698Editorial articleПередовая статьяMetabolic syndrome and insulin resistance in patients with chronic hepatitis CМетаболический синдром и инсулинорезистентность у больных хроническим гепатитом CBayzhanovaZhazira ZhanbulatovnaБайжановаЖазира Жанбулатовна

Кафедра терапии и профзаболеванийаспирант; ММА им. И. М. Сеченова

bzhazira@bk.ruIgnatovaTat'yana MikhaylovnaИгнатоваТатьяна Михайловна

лаборатория изучения ревматологических проблем заболеваний печенид-р мед. наук, вед. науч. сотр; Институт ревматологии РАМН

tmignatova@newmail.ruNekrasovaTat'yana PetrovnaНекрасоваТатьяна Петровна

кафедра патологической анатомииКлиника нефрологии, внутренних и профессиональных болезней им. Е. М. Тарееваканд. мед. наук, доц; ММА им. И. М. Сеченова

tpnekras@mma.ruBaizhanovaZh ZhIgnatovaT MNekrasovaT PММА им. И. М. СеченоваИнститут ревматологии РАМН151020108210NO10 (2010)ТОМ 82, №10 (2010)515609042020Copyright ©; 2010, Consilium MedicumCopyright ©; 2010, ООО "Консилиум Медикум"2010Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/30698

Aim. To estimate the incidence and clinical value of metabolic syndrome, insulin resistance, and steatosis in patients with chronic hepatitis C (CHC) caused by its virus genotype 1. Subjects and methods. One hundred and fourteen patients (67 men and 47 women; mean age 44.9±13.3 years) were examined. Results. There were high incidence rates of metabolic syndrome (47.2%) and insulin resistance (50%), in the genesis of which the host-virus interaction is discussed. There was an independent correlation of the insulin resistance and elevated leptin levels with abdominal obesity and hepatic steatosis; however, these indicators did not correlate with the stage of fibrosis. At the same time hepatic steatosis (found in 38% of the patients) and its degree correlated with the stage of fibrosis. Thirty-four of 66 (54.5%) patients receiving antiviral therapy achieved a stable virological response. Conclusion. Obesity, hyperglycemia, and significant insulin resistance along with the stage of hepatic cirrhosis are independent cofactors that determine no treatment response.

Цель исследования. Оценка частоты и клинического значения метаболического синдрома, инсулинорезистентности и стеатоза у больных хроническим гепатитом C (ХГC), обусловленным 1-м генотипом вируса. Материалы и методы. Обследовали 114 больных (67 мужчин, 47 женщин, средний возраст 44,9 ± 13,3 года). Результаты. Выявлена высокая частота метаболического синдрома (47,2%) и инсулинорезистентности (50%), в генезе которых обсуждается взаимодействие факторов хозяина и вируса. Констатирована независимая корреляция степени инсулинорезистентности, а также повышения уровня лептина с абдоминальным ожирением и стеатозом печени, однако эти показатели не коррелировали со стадией фиброза. В то же время стеатоз печени (обнаружен у 38% больных) и его выраженность коррелировали со стадией фиброза. У 34 из 66 (54,5%) больных, получавших противовирусную терапию, был достигнут стойкий вирусологический ответ. Заключение. Наличие ожирения, гипергликемии и выраженной инсулинорезистентности наряду со стадией цирроза печени служат независимыми кофакторами, определяющими отсутствие ответа на лечение.

chronic hepatitis Cmetabolic syndromeinsulin resistancehepatic steatosisfibrosisantiviral therapyхронический гепатит Cметаболический синдроминсулинорезистентностьстеатоз печенифиброзпротивовирусная терапияAsselach T., Rubbia-Brandt L., Marcellin P., Negro F. Steatosis in chronic hepatitis C: why does it really matter? Gut 2006; 55: 123-130.Negro F. Mechanisms and significance of liver steatosis in hepatitis C virus infection. Wld J. Gastroenterol. 2006; 12: 6756- 6765.Rubbia-Brandt L., Quadri R., Abid K. et al. Hepatocyte steatosis is a cytopathic effect of hepatitis C virus genotype 3. J. Hepatol. 2000; 33: 106-115.Сторожаков Г. И., Никитин И. Г., Банин В. В. и др. Жировая дистрофия печени и хронический HCV-гепатит. Арх. пат. 2000; 62 (6): 27-32.Adinolfi L. E., Gambardella M., Andreana A. et al. Steatosis accelerates the progression of liver damage of chronic hepatitis С patients and correlates with specific HCV genotype and visceral obesity. Hepatology 2001; 33: 1358-1364.Hui J. M., Sud A., Farell G. C. et al. Insulin resistance is associated with chronic hepatitis С and fibrosis progression. Gastroenterology 2003; 125: 1695-1704.Moucari R., Asselah T., Cazals-Hatem D. et al. Insulin resistance in chronic hepatitis C: association with genotypes 1 and 4, serum HCVRNA level, and liver fibrosis. Gastroenterology 2008; 134: 416-423.Serfaty L., Capeau J. Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data. Liver Intern. 2009; 2: 13-25.Douglas M. W., George J. Molecular mechanisms of insulin resistance in chronic hepatitis C. Wld J. Gastroenterol. 2009; 15: 4356-4364.Third Report of National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adult (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-3421.Matthews D. R., Hosker J. P., Rudenski A. S. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419.Lonardo A., Loria P., Carulli N. Dismetabolic changes associated with HCV: a distinct syndrome? Intern. Emerg. Med. 2008; 3: 99-108.Pandya P. K., Shah P., Callahan P. et al. Metabolic syndrome in veterans with chronic HCV infection correlates with NAFLD activity score. Gastroenterology 2006; 130 (Suppl. 2): Abstr. s1915.Grigorescu M., Radu C., Crisan D. et al. Metabolic syndrome, insulin resistance and adiponectin level in patients with chronic hepatitis C. J. Gastrointestin. Liver Dis. 2008; 17 (2): 147- 154.Shaheen M., Echeverry D., Oblad M. G. et al. Hepatitis C, metabolic syndrome, and inflammatory markers: results from the Third National Health and a Nutrition Examination Survey (NHANES III). Diabet. Res. Clin. Pract. 2007; 75: 320-326.Yonossi Z. M., McCullough A. J. Metabolic syndrome, non-alcoholic fatty liver disease and hepatitis C virus: impact on disease progression and treatment response. Liver Int. 2009; 29: 3-12.Harrison S. A. Correlation between insulin resistance and hepatitis C viral load. Hepatology 2006; 43: 1168-1169.Mason A. L., Lau J. Y. N., Hoang N. et al. Association of diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999; 29: 328-333.Zein C. O., Levy C., Basu A. et al. Chronic hepatitis C and type II diabetes mellitus: a prospective cross-sectional study. Am. J. Gastroenterol. 2005; 100: 48-55.Petit J.-M., Bour J.-B., Galland-Jos С. et al. Risk factors for diabetes mellitus and early insulin resistance in chronic hepatitis C. J. Hepatol, 2001; 35: 279-283.Huang J.-F., Dai C.-Y., Hwang S.-J. et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in hepatitis B and C endemic area: an epidemiological link with virological implication. Am. J. Gastroenterol. 2007; 102: 1237- 1243.Romero-Gomez M., Del Mar Viloria M., Andrade R. J. et al. Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology 2005; 128: 636-641.Lo Iacono O., Venezia G., Petta S. et al. The impact of insulin resistance, serum adipocytokines and visceral obesity on steatosis and fibrosis in patients with chronic hepatitis C. Aliment. Pharmacol. Ther. 2007; 25: 1181-1191.Myers R. P., Messous D., Poynard T., Imbert-Bismut F. Association between leptin, metabolic factors and liver histology in patients with chronic hepatitis C. Can. J. Gastroenterol. 2007; 21: 289-294.Romero-Gomez M., Castellano-Megias V. M., Grande L. et al. Serum leptin levels correlate with hepatic steatosis in chronic hepatitis C. Am. J. Gastroenterol. 2003; 1 (8): 1135-1141.Manolakopoulos S., Bethanis S., Liapi C. et al. An assessment of serum leptin levels in patients with chronic viral hepatitis: a prospective study. BMC Gastroenterol. 2007; 7: 17.Leandro G., Magnia A., Hui J. et al. The relationship between hepatic steatosis, inflammation and fibrosis in chronic hepatitis C: a meta-analysis of individual patient data. Gastroenterology 2006; 130: 1636-1642.Charlton M. R., Pocros P. J., Harrison S. A. Impact of obesity on treatment of chronic hepatitis C. Hepatology 2006; 43: 1177-1186.Chu C.-J., Lee S.-D., Hung T.-H. et al. Insulin resistance is a major determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon α-2b plus ribavirin. Aliment. Pharmacol. Ther. 2008; 29: 46-54.Persico M., Capasso M., Persico E. et al. Suppressor of cytokine signaling 3 (SOCS) expression and hepatitis C virus-related chronic hepatitis: insulin resistance and response to antiviral therapy. Hepatology 2007; 46: 1009-1015.